The debate over the ethics of healthcare rationing focuses on three main questions: can medically necessary procedures be denied, is there an unalienable right to unlimited healthcare services regardless of the cost, and what limitations should be placed on a person who can pay (Floyd 2003).
Healthcare rationing occurs because of the demand outpacing supply so organizations allocate services to improve patient outcomes (Rodriguez-Monguio & Villar 2006). This allocation of services to improve patient outcomes is termed total quality management which is focused on organizational change to govern the method of healthcare service delivery (Claus 1991).
The pursuit of perfect quality is not possible because of the imperfections in the guidelines and the flaws of the staff who implement them (Claus 1991). Total quality management is based on meeting consumer expectations and developing plans to improve in deficient areas (Claus 1991).
Evidence based medicine is based on guidelines which identify best practices based on research findings (Norheim 1999). The impact of clinical guidelines on the development of healthcare rationing policies must have consumer support for successful implementation (Norheim 1999). The criteria for accepting clinical guidelines for a particular patient are: validity, importance, and applicability (Norheim 1999).
Evidence based medicine is used by healthcare providers to perform bedside rationing which occurs when a available service is withheld for the benefit of another party over the patient’s best interest (Floyd 2003). Healthcare providers often disguise this type of rationing or justify the rationing to maximize the quality adjusted life years of a patient (Floyd 2003).
Using evidence based medicine and quality management principles in the development of healthcare rationing policies must undergo a process that involves: organizing change, preparing the environment, empowering employees, focusing the environment, engaging the environment (Claus 1991). Providers and patients must understand all risks and benefits of both initiating and withholding treatment to make an informed decision on withholding needed services (Floyd 1993).
There are two major methods of healthcare rationing implicit and explicit rationing. Explicit rationing occurs when a policy is in place that specifically limits and this provide a level of understanding to the patient that all technological services are not limitless (Rodriguez-Monguio & Villar 2006).
Implicit rationing occurs when healthcare services are not rationed by regulations, examples are the waiting list or limiting the number of available providers within an area (Rodriguez-Monguio & Villar 2006). Healthcare resources can also be dividing into primary and secondary rationing.
Primary rationing is when the distribution and the quantity and the distribution are controlled (Monguio & Villar 2006). Secondary rationing occurs when there is a distribution of services which are not controlled by the marketplace (Rodriguez-Monguio & Villar 2006).
The author is interested in determining the role of evidence-based medicine, and quality management principles on the formation of future healthcare rationing policy. With the rapidly rising costs of healthcare service delivery will probably lead to increased healthcare insurance premiums.
This will likely cause President Obama to enact universal healthcare coverage increasing demand on a taxed system and eventually cause the need for formalized healthcare service rationing policies. It seems prudent that these polices should be based on research which involves evidence based medicine and quality management.
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Norheim, O. F. (1999). Healthcare rationing additional criteria needed for assessing
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Rodriguez-Monguio, R., Villar, F. A. (2006). Healthcare Rationing in Spain: Framework,
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